Neurosurgical treatment of anxiety disorders effective -- but risky

Severely ill patients with anxiety disorders or Obsessive-Compulsive Disorder undergoing neurosurgical treatment risk serious complications. The safety of the method must be carefully reconsidered. This according to the largest study made to date on the long-term effects of this surgical method.

"The frequency of adverse effects was higher than expected. Neurosurgery for mental disorders is currently gaining a lot of attention in the professional community with new ongoing trials in several countries and I think our results are another reason for caution", says psychiatrist Christian Rück at Karolinska Institutet in Sweden.

Fifty-one patients with either severe and chronic obsessive-compulsive disorder or other and anxiety disorders have been monitored for up to 23 years following capsulotomy, a neurosurgical operation which involves severing nerve fibres in the central part of the brain.

"Capsulotomy is an effective method for relieving anxiety and obsessions, and its effects remain many years after the operation," says Christian Rück, who has been carefully following up recipients of this treatment. "Many seriously troubled patients feel that the operation saved their lives. There is, however, a serious risk of side-effects."

The results of the study are to be presented in a forthcoming doctoral thesis at Karolinska Institutet. The effects of the operation were measured using questionnaires and thorough interviews with patients and their relatives. The follow-up also included neuropsychological examination and MRI examination of the brain.

One important finding is that the side-effects of the operation are more common than previously thought. Just over a third of the patients displayed signs of apathy and difficulties planning and executing activities. Some patients had developed epilepsy, disinhibition or urinary incontinence.

"There is clearly an unacceptably large risk of adverse reactions to the surgical methods that have been applied to date," says Dr Rück. "The first course of action for patients who don't respond to normal psychiatric treatment should be to use new, non-irreversible neuropsychological techniques."

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Capsulotomy was developed in the 1950s at Karolinska Institutet, and has been used on an average of two patients a year. The latest operation was performed in 2000.

Reference:
Capsulotomy in Anxiety Disorders by Christian Rück, postgraduate student at the Department of Clinical Neuroscience, Karolinska Institutet and psychiatrist on the Anxiety Programme, Psykiatri Centrum Karolinska. See also http://diss.kib.ki.se